麻醉期间3种常用升压药物对SVV干扰规律的临床研究

The Research of the Laws and Correction Methods of Vasoactive Agents on Stroke Volume Variation During Anesthesia

目的 探索麻醉期间常用升压药物麻黄碱、去氧肾上腺素和去甲肾上腺素对心脏每搏输出量变异度(SVV)的具体干扰规律,为寻找合适的校正方法提供依据。方法 搜集60例择期行开颅手术的患者,随机纳入对照组(C组)、麻黄碱组(E组)、去氧肾上腺素组(D组)和去甲肾上腺素组(N组),绘制出各组的ΔSBP-ΔSVV曲线进行统计比较,并从数据库中选择回归方程来获得最佳曲线拟合公式。术毕比较各组的一般临床资料以及术后呕吐、新发昏迷、心律失常、肺炎、二次手术等术后不良事件发生率的差异。结果 3组升压药诱导的ΔSBP-ΔSVV变化曲线存在显著差异。E组最为特殊,表现为在血压上升阶段,ΔSVV先一过性升高后迅速压低;而在血压回落阶段,ΔSVV匀速回升。在各组内进行方程回归后显示,D组和N组的ΔSBP-ΔSVV曲线均最接近米氏方程,但同时N组采用单纯线性回归也可获得较高的拟合度。4组患者在术中一般资料、术后恢复情况及术后不良事件发生率方面,均没有统计学差异。结论 麻黄碱、去氧肾上腺素和去甲肾上腺素对SVV造成的干扰与其诱导的SBP升高之间,存在着各不相同的规律性。去甲肾上腺素相较于其余二者,其诱导的SBP升高与SVV压低之间,呈现最显著的线性趋势。建议在术中使用SVV监测期间如必须使用升压药物,选择去甲肾上腺素泵注更合适,并根据SBP的升高值来量化其对SVV的干扰,从而对原始SVV做出一定的校正,来提升用药期间SVV的临床参考价值。

OBJECTIVE To explore the interference laws of ephedrine,deoxyepinephrine and noradrenaline on SVV during anesthesia,and find the correction methods to these interferences.METHODS Sixty patients under selective craniotomy were randomly assigned into four groups including the control group(group C),the ephedrine group(group E),the deoxyepinephrine group(group D)and the noradrenaline group(group N).Then theΔSBP-ΔSVV curve of each group for statistical comparison were drawed,and the best fit regression equations from the database were found.At last the difference of the intraoperative general clinical data of each group were compared,as well as the postoperative adverse events such as vomiting,new coma,arrhythmia,pneumonia,and secondary surgery.RESULTS TheΔSBP-ΔSVV curves were significantly different in three vasopressor groups.Group E was the most special,which manifested as in SBP rising stage,ΔSVV firstly increased and secondly decreased;while in SBP falling stage,ΔSVV rose constantly.TheΔSBP-ΔSVV curves of Group D and Group N were both closed to Michaelis equation most,but the Group N was also very closed to the simple linear regression equation compared with Group D.There were no statistically significant differences between the four groups in the intraoperative general clinical data and the postoperative adverse events.CONCLUSION The interferences of three vasopressors on SVV are very different.Compared with other two vasopressors,the interference law of norepinephrine pump on SVV is more fit to the linear trend when linking SBP to SVV.Therefore,norepinephrine pump is mostly recommended when vasopressors are necessary during SVV monitoring.Some methods are also recommended to correct the original SVV values by quantifying the increase of SBP,which might improve the clinical reference value of SVV during norepinephrine pumping.